Guiding catheters are instruments that allow a physician to locate and cannulate vessels in a patient's heart for performing various medical procedures, including venography and implanting of cardiac pacing devices. Cannulating heart vessels requires navigating a small diameter, flexible guide through convoluted vasculature into a heart chamber, and then into a destination heart vessel. Once the destination heart vessel is reached, the catheter acts as a conduit for insertion of payloads into the vessel.
The major goal of a guiding catheter procedure is to find and cannulate a vessel of interest in the least amount of time. Finding and cannulating the coronary sinus, for example, can become a time consuming, trial and error procedure even in a healthy patient. Patients exhibiting symptoms of advanced heart disease can have blockages or deformations of heart structure, further complicating the task of locating the opening (ostium) of the coronary sinus from the right atrium.
A pre-shaped guiding catheter has traditionally been used to locate the destination vessel. A fixed shape catheter is adequate in many cases where the pathway is not significantly convoluted and the pathway does not deviate significantly between patients. In situations where structural anomalies or significant variations exist, use of a fixed shape catheter may require that the clinician stock multiple size and shapes of catheters to account for potential variations. Further, it may be necessary that a fixed shaped catheter be swapped out during an implantation procedure with a different shaped catheter due to difficulties in maneuvering.
In some cases, it is desired to have the ability to dynamically shape a distal end of the catheter. Guiding catheters sometimes utilize steering tendons or wires to assist in directing the distal end of the catheter during cannulation. Although this method can be effective, the wires and associated hardware take up valuable space in the guide lumen of the catheter. Also, the relatively long and potentially convoluted passageways traversed by guide catheters lead to complication in the use of steering wires, including pull friction and mechanical backlash.
There is a need for a guide catheter with a maneuverable distal end that does not utilize pull wires. The present invention fulfills these and other needs, and addresses other deficiencies of prior art implementations and techniques.